Plaintiff
Melissa M. Brubaker appeals to the district court from a
final decision of the Commissioner of Social Security
(“Commissioner”) denying her application under
the Social Security Act (the “Act”) for
Disability Insurance Benefits (“DIB”) and
Supplemental Security Income
(“SSI”).[2] (DE 1). For the following reasons, the
Commissioner's decision will be REVERSED, and the case
will be REMANDED to the Commissioner for further proceedings
in accordance with this Opinion and Order.

I.
PROCEDURAL HISTORY

Brubaker
applied for DIB and SSI in November 2013 alleging disability
as of November 1, 2012. (DE 12 Administrative Record
(“AR”) 312-19). The Commissioner denied
Brubaker's application initially and upon
reconsideration. (AR 230-37, 240-45). After a timely request,
a hearing was held on July 23, 2015, before Administrative
Law Judge Stephanie Katich (“the ALJ”), at which
Brubaker, who was represented by counsel, and a vocational
expert, Marie Kieffer (the “VE”), testified. (AR
43-93). On October 15, 2015, the ALJ rendered an unfavorable
decision to Brubaker, concluding that she was not disabled
because despite the limitations caused by her impairments,
she could perform a significant number of light-exertional
jobs in the economy, including cashier, sales attendant, and
cafeteria attendant. (AR 18-29). The Appeals Council denied
Brubaker's request for review (AR 1-14), at which point
the ALJ's decision became the final decision of the
Commissioner. See 20 C.F.R. §§ 404.981,
416.1481.

Brubaker
filed a complaint with this Court on January 13, 2017,
seeking relief from the Commissioner's final decision.
(DE 1). Brubaker advances two arguments in this appeal,
asserting that the ALJ: (1) failed to incorporate all of her
mental limitations into the assigned residual functional
capacity (“RFC”) and the step-five hypotheticals;
and (2) improperly discounted her symptom testimony. (DE 20
at 9-18).

At the
time of the ALJ's decision, Brubaker was 31 years old (AR
29, 296); had attended two years of college and had completed
specialized job training in histotechnology (AR 341); and
possessed past work experience as a histotechnician,
phlebotomist, sales associate, waitress, factory worker, and
home health care assistant (AR 342, 543).

A.
Brubaker's Testimony at the Hearing

Brubaker
testified as follows at the hearing: When asked why she
thought she could not work, Brubaker cited her chronic
pancreatitis, which causes her to experience pain and
vomiting, and her bipolar disorder, which causes her to
become very depressed to where she cannot get out of bed or
leave home. (AR 49). Brubaker held jobs in the past despite
her pancreatitis, which she has had since 2004, but the
condition is worsening in that the pancreatitis attacks are
occurring more frequently. (AR 50). She finds it hard to eat
most of the time, and she has trouble sleeping; her anxiety
about her pancreatitis then triggers her mental health
issues. (AR 50, 67-68). She estimated that she sleeps just
three hours a night; she was not taking any sleep aide
medications. (AR 68, 71). She experiences pain throughout the
day, ranging from soreness when relaxed to sharp pain during
spasms. (AR 70-71).

Brubaker
had not seen a specialist for her pancreatitis since 2012 due
to financial concerns and a lack of health insurance. (AR
53). She was not taking any prescription medications for her
pancreatitis, but seeks care from an emergency room if needed
when she has an acute attack. (AR 53-54, 56). Her
pancreatitis attacks are triggered by stress and eating, so
she tries to avoid both; when she does eat, she consumes very
small amounts of bland food. (AR 54-55). When she feels the
onset of spasms, she stops eating, lies down and rests, and
tries to avoid stress in order to relax her muscles; she also
uses heat and takes hot baths. (AR 54-56).

Brubaker
takes prescription medication for her mental health issues,
including a bipolar disorder, but still feels “very
nonfunctional.” (AR 57). She complained of racing
thoughts, constant worry, and no motivation. (AR 68-69). She
stated that the medication controls her mood swings, but
makes her feel numb. (AR 57-58). She had not been to a
therapist in the past year due to her limited finances, but
she had an appointment to start again.[4] (AR 58).

B.
Summary of the Relevant Medical Evidence

In
2005, Brubaker was diagnosed with chronic pancreatitis by Dr.
Glen Lehman, a specialist at the IU School of Medicine. (AR
786, 1547-1552). She had a trial of biliary stenting and
biliary sphincterotomy that did not improve her pain. (AR
786). An upper endoscopic ultrasound in December 2006 showed
mild chronic pancreatitis, and she underwent a successful
celiac plexus block. (AR 1773-74). In 2007, Brubaker was seen
three times at the University of Cincinnati by Dr. Shailendra
Chauhan, a gastroenterology specialist. (AR 1730-39). Dr.
Chauhan thought that Brubaker's problems were due to
irritable bowel syndrome and not pancreatitis. (AR 1731).
From January 2007 to May 2009, Brubaker was treated by
gastroenterology specialists at Lutheran Medical Group. (AR
1553-1628).

In
2009, Brubaker returned to Dr. Lehman, who gave her three
options to manage her chronic pain: pain management, a
feeding tube, or a pancreas transplant. (AR 786). Brubaker
chose pain management, and Dr. Lehman prescribed Creon and
Vicodin. (AR 786).

In
September 2009, Brubaker entered a partial hospitalization
program for anxiety and depression. (AR 597-600). She was
diagnosed with major depression, recurrent, severe without
psychosis; and panic disorder without agoraphobia. (AR 599).
She was assigned a Global Assessment of Functioning
(“GAF”) score of 48 upon admission and a
past-year score of 65.[5] (AR 599).

In
2010, Brubaker visited the emergency room twice for her
abdominal symptoms. (AR 663, 730). Brubaker saw Dr. Steven
Hatch, a pain management specialist, three times from
November 2010 to February 2011. (AR 670-78). Brubaker's
goal was to wean down her pain medications, and Dr. Hatch
adjusted her medications at each visit. (AR 671, 674). On a
10-point scale, Brubaker rated her pain as an
“eight” at her first appointment, a
“six” at her second appointment, and a
“four” at her third appointment. (AR 670, 673,
676).

In
November 2010, Brubaker was hospitalized after her husband
found her acting strangely. (AR 620-25). It was suspected
that she had abused prescription medications; Brubaker was
uncooperative and denied that she was abusing prescription
drugs. (AR 620-21, 625). The doctor concluded that Brubaker
had taken more medication than prescribed. (AR 621, 625).
Brubaker was diagnosed with a depressive disorder, not
otherwise specified (“NOS”); an anxiety disorder,
NOS; rule out drug dependency; and rule out a drug-induced
mood disorder. (AR 621).

Brubaker
was hospitalized again in December 2010, admitting that she
was abusing prescription narcotics and complaining of
abdominal pain, suicidal thoughts, insomnia, depression,
panic attacks, and anxiety. (AR 644-46). She was placed in a
chemical dependency program. (AR 646). She was not working
and was not able to care for her two-year-old son. (AR 645).
She was assigned a GAF score of 60 and diagnosed with a
depressive disorder, NOS; an anxiety disorder, NOS; drug
dependence, narcotics; a drug-induced mood disorder; and a
borderline personality disorder. (AR 644).

In
February 2011, Brubaker saw Dr. Edward Schultz, of Parkview
Physicians Group, complaining of abdominal pain, depression,
diminished stamina, anorexia, confusion, diarrhea, nausea,
and vomiting. (AR 774-77). She was taking Percocet three
times daily for her pain. (AR 783). She had recently received
hospital outpatient care for anxiety attacks. (AR 774). She
admitted to suicidal ideation and a previous addiction to
pain medications. (AR 776). She was attending Alcoholics
Anonymous meetings to address her non-alcohol addictive
issues. (AR 776). She was overwhelmed by her medication
situation and bills. (AR 776). Dr. Schultz adjusted her
medications and referred her for some laboratory testing. (AR
776).

Brubaker
saw Dr. P. Rustagi four times in early 2011. (AR 682-83,
739-41). In February, she complained of panic attacks and
suicidal thoughts and had been abusing prescription pain
medication. (AR 682). She was diagnosed with a bipolar
disorder and assigned a GAF score of 50. (AR 683). In March,
Brubaker reported a good response to her current medication
regime and that she was complying with her medications. (AR
741). In April, Brubaker reported that she was feeling well
and was still complying with her medications. (AR 740). In
June, Brubaker reported that life had been going reasonably
well for her and that her mood had been fairly content and
stable. (AR 739). She had been taking her medications
sporadically and thought her mental health was “in good
shape, ” so she wanted to taper off of her medications.
(AR 739).

In
August 2011, Brubaker was hospitalized for a week due to
abdominal pain, chronic pancreatitis, and wall thickening of
her colon. (AR 743-47, 770). She had stopped all of her
medication five months earlier. (AR 743). She was treated
with intravenous narcotic pain management and antiemetics.
(AR 747). Brubaker saw Dr. Schultz after she was discharged.
(AR 770-73). Brubaker told Dr. Schultz that she had stopped
all of her medications five months earlier, and that since
that time she has had repeated episodes of abdominal
discomfort lasting several days at a time that eventually
resolved spontaneously. (AR 770). In the last three weeks,
her pain had become more recalcitrant. (AR 770). He
recommended that she undergo further consultation and
testing. (AR 773).

In
September 2011, Brubaker was evaluated by Park Center upon
self referral. (AR 950-59). Brubaker admitted a history of
misuse of opiate pain medications. (AR 950). She presented
with anxiety and depression. (AR 950). She was diagnosed with
opioid dependence and cannabis abuse. (AR 957-58). Treatment
at Park Center continued through July 2015; Brubaker
inconsistently attended treatment, which impacted her
progress. (AR 950-67, 1001-32, 1037-74, 1126-71, 1388-1424,
1456-1545). Diagnoses of a bipolar II disorder and a major
depressive disorder, single episode, moderate, and an anxiety
disorder, NOS, were subsequently added. (AR 1008, 1016,
1171). She was ...

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